Pediatricians’ reported use of developmental screening tools increased significantly to 63% from 2002 to 2016, based on survey data from more than 1,000 pediatricians at three time points.
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“In 2001, an AAP [American Academy of Pediatrics] policy statement called for pediatricians to screen all children for developmental disorders during routine well-child visits,” Paul H. Lipkin, MD, of the Kennedy Krieger Institute, Baltimore, and colleagues wrote in Pediatrics. “However, only 23% of pediatricians in 2002 reported using a standardized developmental screening tool, citing lack of time, staff, and reimbursement as barriers.”
To determine trends in pediatricians’ use of recommended screening tools, the researchers reviewed data from the American Academy of Pediatrics Periodic Surveys in 2002, 2009, and 2016 that included 562, 532, and 469 respondents, respectively.
The percentage of pediatricians who reported using screening tools increased from 21% in 2002 to 63% in 2016 (P less than .001). In addition, The screening tool with the greatest increase in use was the Ages and Stages Questionnaire (ASQ), reportedly used by 48% of pediatricians in 2016, up from 9% in 2002 (P less than .001).
Most reported barriers to screening, including time constraints, inadequate reimbursement, lack of staff to perform screenings, belief that screening is not an appropriate role for pediatricians, and lack of confidence in the screening effectiveness, declined over the study period. However, the percentage of pediatricians who reported lack of available treatment options as a barrier to screening increased from 9% in 2002 to 21% in 2016, the researchers noted.
The average ages of the survey respondents at the 2002, 2009, and 2016 time points were 44, 47, and 49 years, respectively, and the majority (44%, 45%, and 49%) worked in suburban practice areas.
The study findings were limited by several factors, including the use of self-reports, the potential bias of pediatricians to overestimate some of their developmental practices, and potential over- or underreporting if autism spectrum disorder screening was mistakenly included, Dr. Lipkin and associates noted. The results suggest that use of standardized screening has increased, but more attention is needed to improve screening and referrals.
Potential improvements include adding screening tests and referrals to EHRs, and improving communication between medical practices and community-based intervention, therapy, and education programs, they concluded.
The study findings can be seen as encouraging, but one-third of pediatricians still reported not using formal screening instruments, commonly citing lack of time and suboptimal reimbursement, Mei Elansary, MD, and Michael Silverstein, MD, both of Boston University, said in an accompanying editorial.
However, “Although time and financial barriers are real, it is also likely that some of the residual gaps in guideline-concordant practice reflect variability among pediatricians in their perception of the clinical relevance of certain developmental problems that require formal instruments to identify and in the availability and effectiveness of services targeted to children with these less severe developmental issues,” they said. The path for screening children with developmental risk factors but not obviously severe delays may not be straightforward, and many pediatricians rely on their clinical judgment, they emphasized.
“As important as developing strategies to achieve more widespread developmental screening, therefore, is developing a greater understanding of the root causes of practice variation and determining the range of viable clinical practices that lead to better developmental outcomes,” Dr. Elansary and Dr. Silverstein concluded.
The study was supported by the American Academy of Pediatrics, the Department of Health & Human Services, the Health Resources and Services Administration, and the Department of Education Office of Special Education Programs. The researchers had no financial conflicts to disclose.
Editorialist Dr. Silverstein disclosed an award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the editorial was funded by the National Institutes of Health. Dr. Silverstein is a member of the U.S. Preventive Services Task Force. Dr. Elansary had no relevant financial disclosures.
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SOURCES: Lipkin PH et al. Pediatrics. 2020 Mar 2. doi: 10.1542/peds.2019-0851; Elansary M, Silverstein M. Pediatrics. 2020 Mar 2. doi: 10.1542/peds.2020-0164.